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EAU 2018

EAU 2018: Perioperative Major Acute Cardiovascular Events After 180-Watt Green Light Laser Photoselective Vaporization

Copenhagen, Denmark (UroToday.com)  Dr. M. Marchioni, clinical urologist from the Università Degli Studi in Chieti, Italy, presented a cohort of prostate resection patients who are at a high bleeding risk due to the inability of anticoagulant or antiplatelet drugs could not be suspended. In these patients, the gold standard treatement to reduce blood loss is 180-Watt Green Light (180-W GL) laser photoselective vaporization (PVP). Using patients from this cohort who underwent 180-W GL PVP treatment for benign prostatic hyperplasia (BPH), Dr. Marchioni and his team attempted to evaluate Major Acute Cardiovascular Events (MACE) and how these events could represent serious complications with difficult management. Particularly, the morbidity of the PVP procedure was sought to be evaluated in patients who were currently taking antiplatelet (Clopidogrel) or anticoagulant medications according to their preoperative management.

Dr. Marchioni presented his findings from a multi-institutional, prospective database analysis on 923 patients who underwent 180-W GL PVP from 14 different medical centers. Of these patients, 16 (1.7%) were found to have suffered from MACE in 7 centers. The perioperative morbidity for minor (Clavien < 3), major complications (Clavien ≥ 3), and hemorrhagic complications were recorded. It was also determined whether or not the preoperative management of medication was continued or stopped by the time of surgery. Aspirin was never stopped under any circumstance and acted as a control. 

In a head-to-head comparison between the Aspirin group and the Clopidogrel group, whether the latter was stopped or continued, revealed that the Clpidogrel group had a significantly greater percentage of major complications and hemorrhagic complications than the Asprin group. It was shown that Clopidogrel was four times and two times as likely to develop major complications and hemorrhagic complications, respectively, over the Aspirin group when performing 180-W GL PVP. Anticoagulant therapy, however, had no significant difference compared to the Aspirin group. 

In closing, Dr. Marchioni reiterated how Clopidogrel did have an effect on major and hemorrhagic complications during PVP while anticoagulants had no increased morbidity. In order to further confirm these results, a prospective, randomized trial is necessary. 


Presented by: M. Marchioni, MD Universit. Degli Studi "G.D'Annunzio", Dept. of Urology, Chieti, Italy

Co-Authors: Marchioni M.1, Cindolo L.2, De Nunzio C.3, Greco F.4, Destefanis P.5, Bergamaschi F.6, Ferrari G.7, Fasolis G.8, Palmieri F.9, Divan C.10, Oriti R.11, Ruggera L.12 , Tubaro A.3, Dadone C.13, De Rienzo G.14, Frattini A.15, Mirone V.4, Ricciardulli S.6 , Varvello F.8 , Voce S. 16 , Malossini G.10, Tuccio A.11 , Chiodini P.17, Ditonno P.18 , Campobasso D.15 , Schips L.19

Author Information:
1. Universit. Degli Studi "G.D'Annunzio", Dept. of Urology, Chieti, Italy 
2. ASL 2 Abruzzo, Dept. of Urology, Chieti, Italy
3. "S.Andrea" Hospital, Sapienza University, Dept. of Urology, Rome, Italy 
4. "Federico II" University of Napels, Dept. of Urology, Naples, Italy
5. Azienda Ospedaliera Citt. della Salute e della Scienza di Torino, Dept. of Urology, Turin, Italy
6. Arcispedale Santa Maria Nuova, Dept. of Urology, Reggio Emilia, Italy
7. "Hesperia" Hospital, Dept. of Urology, Modena, Italy 
8. "S. Lazzaro" Hospital, Dept. of Urology, Alba, Italy, 9. "Santa Maria delle Croci" Hospital, Dept. of Urology, Ravenna, Italy
10. Rovereto Hospital, Dept. of Urology, Rovereto, Italy
11. Ulivella e Glicini Clinic, Dept. of Urology, Florence, Italy 
12. Azienda Ospedaliera - University of Padua, Dept. of Urology, Padua, Italy
13. "Santa Croce e Carle" Hospital, Dept. of Urology, Cuneo, Italy 
14. University of Bari, Dept. of Emergency and Organ Transplantation, Urology and Andrology Unit, Bari, Italy 
15."Ercole Franchini" Hospital, Dept. of Urology, Montecchio Emilia, Italy 
16.“Santa Maria delle Croci Hospital”, Dept. of Urology, Ravenna, Italy
17. Second University of Naples, Medical Statistics, Naples, Italy
18. Univerisity of Bari, Dept. of Emergency and Organ Transplantation, Urology and Andrology Unit, Bari, Italy, 19SS Annunziata Hospital, Dept. of Urology, Chieti, Italy

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark